Medicare:

Impact of OBRA-90's Dialysis Provisions on Providers and Beneficiaries

HEHS-94-65: Published: Apr 25, 1994. Publicly Released: Apr 25, 1994.

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Pursuant to a legislative requirement, GAO provided information on how Medicare End-Stage Renal Disease Program (ESRD) patients are affected by provisions requiring employer-sponsored health care plans to pay for dialysis before Medicare does, focusing on the: (1) amount of money dialysis providers receive; and (2) out-of-pocket payments that Medicare beneficiaries make.

GAO found that: (1) dialysis providers received an average of 80 percent more money when employer-sponsored plans acted as primary payer; (2) Medicare paid very little of the average that providers received; (3) the extension of the secondary-payer requirement increased provider revenues only 1.8 percent, but increased providers' profit margins significantly; and (4) the extension did not significantly increase beneficiaries' out-of-pocket costs, but ESRD patients could experience increased out-of-pocket costs if their employers limited dialysis coverage.

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